Provider Demographics
NPI:1073736773
Name:SERRANO, ANDREA JOY
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:JOY
Last Name:SERRANO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 WEST WETMORE ROAD
Mailing Address - Street 2:AMPHITHEATER PUBLIC SCHOOLS
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85705-1547
Mailing Address - Country:US
Mailing Address - Phone:520-696-5237
Mailing Address - Fax:520-696-5067
Practice Address - Street 1:701 WEST WETMORE ROAD
Practice Address - Street 2:AMPHITHEATER PUBLIC SCHOOLS
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85705-1547
Practice Address - Country:US
Practice Address - Phone:520-696-5237
Practice Address - Fax:520-696-5067
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP0017235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ541103Medicaid